rickyp wrote:Income-based premium subsidies would be replaced by age-based subsidies, which will hurt working-class families in many states. Under the ACA, subsidies to help individual buyers afford premiums and (for poorer households) deductibles and co-pays were based on household income. The GOP measure will base them on the buyer’s age, instead, with older buyers receiving more help than younger. The GOP plan limits subsidies to $4,000 per individual; under the ACA, which also keys subsidies to the cost of benchmark insurance plans in the buyer’s home market, the subsidies theoretically could be several times higher. No family could receive more than $14,000 in subsidies, and no more than five family members could be eligible for subsidies.

I think health care in the US is an intractable problem which the Republicans now own. In time it will be an intractable problem that the Dems own

At least until someone like Bernie convinces everyone that Medicare for all will work.Then the problems are similar to other countries. Keeping costs down. However, as other countries have proven, when you have regulated costs, you do keep costs down.

In 2009, Pelosi said the ACA had to pass before we could find out what was in it. In 2017, she demands Republicans release the details before it's voted on. I happen to think what was done in 2009 was skulduggery, but it takes nerve to demand what you refused to do yourself.

In 2017, the Democrats are so concerned with costs. In 2017, Republicans aren't. Neither party seems to care as long as it's in power.

In 2009, Pelosi said the ACA had to pass before we could find out what was in it. In 2017, she demands Republicans release the details before it's voted on. I happen to think what was done in 2009 was skulduggery, but it takes nerve to demand what you refused to do yourself.

In 2017, the Democrats are so concerned with costs. In 2017, Republicans aren't. Neither party seems to care as long as it's in power.

In 2009, Pelosi said the ACA had to pass before we could find out what was in it. In 2017, she demands Republicans release the details before it's voted on. I happen to think what was done in 2009 was skulduggery, but it takes nerve to demand what you refused to do yourself.

There is little equivalence between the process in 2009 and the current process.

In considering the Affordable Care Act in 2009 and 2010, the House held 79 hearings over the course of a year, heard from 181 witnesses and accepted 121 amendments. The current House leadership hopes to get the repeal and replacement legislation through the House in three weeks. The Senate adopted the Affordable Care Act only after approximately 100 hearings, round tables, walk throughs and other meetings, and after 25 consecutive days in continuous session debating the bill. It is expected that the current House bill will go directly to the floor of the Senate for a vote.

Sen. Cotton: House GOP moving 'too quickly' on Obamacare repeal.In the Senate, four Republican members have come out against the bill, unhappy over its cuts to Medicare. And Sen. Lindsey Graham (R-S.C.) has, like Cotton, expressed an interest in slowing down the process and ensuring that it is done correctly. “We're not going to be judged by when we did it but how we did it,” he told reporters on Tuesday.

In 2009, Pelosi said the ACA had to pass before we could find out what was in it. In 2017, she demands Republicans release the details before it's voted on. I happen to think what was done in 2009 was skulduggery, but it takes nerve to demand what you refused to do yourself.

In 2017, the Democrats are so concerned with costs. In 2017, Republicans aren't. Neither party seems to care as long as it's in power.

When Pelosi said that, was the bill being hidden?

Was it?

Even if not, how many pages was it? If the Speaker had not read it, as she indicated, then who had?

In other words, for all practicality, yes, it was hidden.

Furthermore, there are the tens of thousands of regulations to implement it.

even if the current proposal were to pass, it has a LOT of amendments waiting to be added. No where does it mention competition across state lines. This is of course something the Republicans want and most people do support (Even Rickyp says it will help despite him saying otherwise ..a "negligible" effect is still a positive step albeit minor). This is far from a done deal by any means. It really shows us how stupid the system is in how bills like this are often used....I am not saying this is a good plan, only that it is far from what the final proposal will look like. I am also laughing at the Dems and how they simply refuse to accept anything other than what we now have. Flat out refusal to make things better even though Obamacare is falling apart, they want no fixes, only to be obstructionists. The Republicans are no saints, they did the exact same thing a few years ago! But why is it our liberals simply fail to see things as they are? They don't see them being obstructionists, they can only see Republicans trying to force their agenda and fail to recall they did the same damned thing not to long ago. Both parties should be ashamed of themselves but at least the Republicans can see clearly.

What limited experience the nation does have with across-state-lines sales suggests it won’t work. A 2012 Georgetown University Health Policy Institute report scrutinized six states that have enacted this type of reform, finding that it “did not result in a single insurer entering the market or the sale of a single new insurance product.” Nor did it reduce coverage costs. “Our findings suggest that across-state-lines legislation does not appear to be the ‘silver bullet’ that proponents are searching for,” the report’s authors concluded.

. I am also laughing at the Dems and how they simply refuse to accept anything other than what we now have. Flat out refusal to make things better even though Obamacare is falling apart, they want no fixes, only to be obstructionists.

I guess you think this way because you don't get an even handed supply of news....Because i find all kinds of references to their being open to improvements

If the Affordable Care Act is repealed, a "surprising number" of Democratic lawmakers have shown an openness to helping Republicans replace the law, Burgess Everett and Jennifer Haberkorn report for Politico.

In 2017, the Democrats are so concerned with costs. In 2017, Republicans aren't. Neither party seems to care as long as it's in power.

The Ryan bill removes the "Cadillac tax" which was scheduled to take place in a few years. It basically taxes income for those who have very expensive health insurance plans. Traditionally corp exec and unions have opposed this tax because they have the best insurance plans.

The ACA tax was cynical in that it only took place in the back end years of the 10 year scoring period. This resulted in revenues to pay for the ACA. Of course many of the costs were frontloaded, so this was just a budget game. I've seen many a business that show losses in the early years and then develop hockey stick assumptions for the later years. Multiply it be a market multiple, and voila, you have a good investment. I'm a spreadsheet jockey and have done my share of this for companies. Surprise, surprise, government forecasters do it too. As soon as we design a methodology (such as a bill has to be revenue neutral over a 10 year period) we design a set of assumptions that defer pain for as long as possible (we will add a large tax in year 8 or we will cut Medicare payment rates in year 9, etc.). The problem is further compounded because companies would change behavior were the tax to be instituted, so it would not generate as much revenue as indicated.

My question concerns Ryan's plan to eliminate the Cadillac tax. The non-taxability of company paid health insurance is one of the reasons that the US insurance market is expensive and distorted. Although the ACA set up this tax in a cynical fashion, I wonder whether the removal is the way to go. Why not leave it in there. Then the Ryan plan would truly show 1.2 Trillion of savings. When we do tax reform, we could then use that better structure the Cadillac tax.

Ray Jay wrote:My question concerns Ryan's plan to eliminate the Cadillac tax. The non-taxability of company paid health insurance is one of the reasons that the US insurance market is expensive and distorted. Although the ACA set up this tax in a cynical fashion, I wonder whether the removal is the way to go. Why not leave it in there. Then the Ryan plan would truly show 1.2 Trillion of savings. When we do tax reform, we could then use that better structure the Cadillac tax.

Here's a completely different idea. We subsidize mortgages via the tax code because we want people invested in the system. So, instead of taxing employer-supplied healthcare (which will mean less of it), what if it was subsidized by tax write-offs to the point that it encouraged employers to provide healthcare plans? And, for smaller businesses, allow them to group together.

I suspect, based on Ryan's statements today (about being willing to make changes and Trump being heavily involved), that the GOP plan will continue to evolve. Hopefully, those changes will be for the better.

The non-taxability of company paid health insurance is one of the reasons that the US insurance market is expensive and distorted

Expensive and distorted compared to what?The entire health insurance industry and the administration surrounding are what distorts the cost of medical care in the USA. Period.

... as countries spend a larger percentage of their healthcare dollars on administration (as opposed to public health, or providing patient care, for example), things get worse for patients and healthcare providers. High administrative expenditures seem to be associated with negative experiences of providing and receiving healthcare.

As a 2014 New York Times headline put it: Medicine’s Top Earners Are Not the M.D.s. The U.S. devotes a larger percentage of it healthcare economy to administration (doing things like moving a claim through the system, answering patient phone calls, and yes, paying the innumerable and sometimes incomprehensibly large salaries of administrators at insurers, hospitals, and healthcare systems) than any other country

The problem with the ACA is that it propped up the insurance industry. Ryan Care only makes it worse.What does the heath insurance industry actually do that adds value to the health care system? If it doesn't add value for the overhead it loads onto the system, why have it?

?Not at all. I'm pointing out that fiddling around the margins on what insurance delivery can cost isn't going to have a significant out come. The US system is almost twice as large a factor in your entire economy as other western democracies. And the most striking difference is that you have an insurance industry that, through increasing complexity drives up the basic cost of delivering health care enormously. And provides nothing of value. The US health insurance industry likes to point out that it works on small profit margins. 4 to 6%. If it were an efficient industry, this would mean that all the competition in the world could only drive costs down by some factor of the profit margin. But it is an enormously inefficient beast with enormous staffs and outsized executive compensations. All based upon the simple task of taking money from insurance premiums and paying out claims. Profit is made by paying out fewer claims than premiums taken in (plus any investment income) . Which in the US means insurers are stingy about payments. Single payer systems eliminate most of the overhead and eliminate overheads for employers and hospitals.... they immediately have a cost delivery advantage. But so far, the debate in the US seems to be about fine tuning the insurance industry and incentives around the insurance industry rather than just admitting the whole insurance system is fundamentally ineffective and inefficient. And moving on from it to a system where health care expenditure isn't on administration but actual health care. Imagine if a company could get rid of most of its staff handling their health insurance benefits programs, where hospitals could stream line their accounting department because the complexity of dealing with dozens if not hundreds of different insurance companies would be ended, and where the administrators of medicare for all could easily manage the program with fewer people because their job would not be denying claims to increase profits.